Jonathan Slonin, an anesthesiologist and past president of the Florida Society of Anesthesiologists, believes that lawmakers should not allow the administration of anesthesia without a physician in the room. Although he works with and respects Certified Registered Nurse Anesthetists (CRNAs), they are not physicians.
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They have years of training, but they are not trained in medical diagnosis and treatment, and while they are highly skilled and a vital part of the medical care team, they should never be the lead of that team.
While the American Association of Nurse Anesthetists are advocating for a proposed bill that would allow CRNA’s to practice without the supervision of a physician, some see this as a dangerous and costly move.
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...safety should be the primary goal and that is why physician-led care must remain the standard. If CRNAs were given complete independence to practice complex medicine, costly mistakes will happen. And when they do, we all pay for those mistakes through increased healthcare costs.
So these scientific studies take into account everything? I can guarantee you that if there is a complex case, an MD will be overseeing it. So even if both CRNAs and MDs have equivalent outcomes, that doesn’t mean that the competence is equal. Also, the studies I’ve seen don’t include near misses as incidents. Studies have limitations. Sometimes you have to take a step back and look at the actual education. Premed, medical, residency, fellowship, and attending practice.
So these scientific studies take into account everything? I can guarantee you that if there is a complex case, an MD will be overseeing it. So even if both CRNAs and MDs have equivalent outcomes, that doesn’t mean that the competence is equal. Also, the studies I’ve seen don’t include near misses as incidents. Studies have limitations. Sometimes you have to take a step back and look at the actual education. Premed, medical, residency, fellowship, and attending practice.
But that's not what we're talking about. Not requiring physician oversight doesn't mean that collaboration never occurs---this is a common misconception. I am a CNM. I cannot do my job without collaborative relationships with OBs. I currently work in a state that requires a formal collaborative agreement, but midwives who don't aren't having worse outcomes. They still collaborate, there's just less red tape and paperwork involved. Along the same vein, CRNAs will always need to work with MDAs on complex cases. But insisting that every case and every CRNA need to be supervised by an MD is ridiculous and completely cost ineffective. I don't know what you mean by studies taking "everything" into account but by and large, studies bear out the safety of CRNAs. And if studies always have limitations, how else do you suggest the issue be explored? You keep pressing the point about MDAs having more education but all I and other posters are trying to point out is that their extra education does not matter in the long run---CRNAs are just as competent, so it makes more sense for our healthcare system to use the more cost effective option.
CRNA's can't do ALL the anesthetics on any given day but they can do 90% of them...alone or with collaboration, depending on the institution. This goes back to an old study by Kaiser in California done in the 90's (I think!) when MDA's and CRNA's were given a questionaire re: the percentage of cases requiring MDA "supervision." BOTH groups agreed on a figure around 90%. I remember this well because it struck me as a sensible figure. It's just not rocket science....it requires attention to detail, good psychomotor skills, and generous doses of science as well as artistry. Our body of knowledge is so small compared to other specialties. And I wonder....what's it to YOU, Army RNtoMD? If the patients, hospital administrators and surgeons are happy with our care....just what IS it to you?
Of course hospital administrators are happy with the care. They like whatever saves them a buck. I don’t know which surgeons you’ve talked to, but all of the surgeons I’ve talked to beg to differ. I haven’t had many patients opinions on CRNAs since... they don’t interact with them really. They probably hardly know if they have a CRNA or an MD administering. I have however heard MANY patients angry or frustrated that they want to “talk to the actual doctor and not some NP”. Which I can kind of relate to. If I have something minor I need, such as a prescription refill, I want to be seen ASAP, whoever it is. But if it’s something complex, I want to speak to the doctor. I say this after having been a patient, and had an NP not be able to tell me anything more specific than I know about my disease process just being an RN. Extremely general. Every time I speak to the gastroenterologist he has much more precise explanation that actually puts me at ease and makes me feel informed.
Midlevels are great with supervision. I just don’t agree with independent practice. And when it comes to NPs having no practice requirements (how the hell is someone going to go straight from nursing school to be an NP without several years of ICU experience?) and these degree mills online, I see it as a bubble that will eventually burst.
Of course hospital administrators are happy with the care. They like whatever saves them a buck. I don’t know which surgeons you’ve talked to, but all of the surgeons I’ve talked to beg to differ. I haven’t had many patients opinions on CRNAs since... they don’t interact with them really. They probably hardly know if they have a CRNA or an MD administering. I have however heard MANY patients angry or frustrated that they want to “talk to the actual doctor and not some NP”. Which I can kind of relate to. If I have something minor I need, such as a prescription refill, I want to be seen ASAP, whoever it is. But if it’s something complex, I want to speak to the doctor. I say this after having been a patient, and had an NP not be able to tell me anything more specific than I know about my disease process just being an RN. Extremely general. Every time I speak to the gastroenterologist he has much more precise explanation that actually puts me at ease and makes me feel informed.
Midlevels are great with supervision. I just don’t agree with independent practice. And when it comes to NPs having no practice requirements (how the hell is someone going to go straight from nursing school to be an NP without several years of ICU experience?) and these degree mills online, I see it as a bubble that will eventually burst.
I hear you about that one! There as absolutely NO COMPARISON between the requirements of NP education vs. CRNA...NONE. And I know you are a doc now so probably don't go through all of AN, but I do, just to keep up with what's evolving. It's very discouraging to tons of RN's how lax our "profession" has become re: educational standards. But when you go to CRNA school (which is now pretty much 3 years long with the new DNAP requirement looming over the new students), you have no life. It is all day, every day. It is doing ICU, OB, and cardiac rotations. You can't work and you have to show up and be there full-time. The chairman of my department requested me to give him a general - and I say this only to point out his comfort level with the CRNA's in his department. This wasn't a little rural hospital - we were doing over 10,000 anesthetics in 7 rooms/year. It's where I developed my own PTSD over production pressures:). If we can't depend on statistics to measure outcomes, well, what else can we do? Your opinion isn't a scientific method.
BTW, I slaved over the machine for 37 years and saw a lot of schools of thought come and go. So, you are really going to have to PROVE what you are saying. I know, I know - lying statistics, but how else can we conduct rational inquiry. We need more internists, rheumatologists, endocrinologists - not more anesthesiologists doing a CRNA's job.
hear you about that one! There as absolutely NO COMPARISON between the requirements of NP education vs. CRNA...NONE. And I know you are a doc now so probably don't go through all of AN, but I do, just to keep up with what's evolving. It's very discouraging to tons of RN's how lax our "profession" has become re: educational standards. But when you go to CRNA school (which is now pretty much 3 years long with the new DNAP requirement looming over the new students), you have no life. It is all day, every day. It is doing ICU, OB, and cardiac rotations. You can't work and you have to show up and be there full-time. The chairman of my department requested me to give him a general - and I say this only to point out his comfort level with the CRNA's in his department. This wasn't a little rural hospital - we were doing over 10,000 anesthetics in 7 rooms/year. It's where I developed my own PTSD over production pressures:). If we can't depend on statistics to measure outcomes, well, what else can we do? Your opinion isn't a scientific method.
BTW, I slaved over the machine for 37 years and saw a lot of schools of thought come and go. So, you are really going to have to PROVE what you are saying. I know, I know - lying statistics, but how else can we conduct rational inquiry. We need more internists, rheumatologists, endocrinologists - not more anesthesiologists doing a CRNA's job.
I’m not a doc yet. I’m a CCRN still. And don’t get me wrong, I have a ton of respect for CRNAs. I just don’t see what the downside for having physician oversight is.
I’m strongly against NP independent practice, less so for CRNA independent practice.
NP school needs to be tightened up. Several friends went through and much of it is repeat basic stuff from even pre nursing. One nurse I worked with was telling me “I’m in NP school and learning about antibiotics! Did you know they work in different ways?!” And was explaining it to me. I told her “Y’all didn’t learn that in medical micro? We had to know the mechanisms of the different types. The cephalosporin generations, adjunct drugs etc”
And don’t get me started on RN to BSN. That was the biggest time wasting joke I’ve ever seen. People were posting on the discussion forum that were obviously barely literate. One still stands out.
“Let’s say your maw says you gonna bake a cake. And you says to her okay what we need to bake this here cake?”
The downside is that it is very expensive for an MDA to do the job of a CRNA. It's irrational, illogical and wasteful. It makes no acknowledgement of having the appropriately trained practitioner matched to the demands of the job. Don't you think it's crazy that MD's are delivering most of the babies when every other country in the world uses midwives and have better infant mortality statistics? Why would an MD ever be participating in a healthy, normal delivery? Wrong person for the wrong job. I know in anesthesia, some of the academic folks get burnt out and leave academia for corporate practice so we are now paying a talented specialist to do a CRNA's job at inflated rates. Hey, you CHOSE to do a pediatric and an anesthesia residency. You've invested time, money and intellectual energy to do it and now you have to show your face at an induction for a D and C and watch someone else induce the patient while you just stand there? That's crazy. I'm sorry you need to make more money to "survive" so you abandon your job and then want to threaten mine? AND, you are generally doing a CRNA job collecting an MDA rate. It's like requiring a neurosurgeon to do a spinal tap (which I did hundreds of times very nicely, thank you:) As generations of CRNA's did them well before me. Hey, CRNA's perfected ether anesthesia and it was an awful drug.
Not sure how giving CRNAs and even NPs limited independent practice is an issue. It isn't like someone is saying they should have completely unlimited scopes.
CRNAs are not anesthesiologists nor should they have a full scope like an MDA but why shouldn't they practice independently with a somewhat more limited scope?
Specializes in Nurse Leader specializing in Labor & Delivery.
22 hours ago, ArmyRntoMD said:
I’m not a doc yet. I’m a CCRN still. And don’t get me wrong, I have a ton of respect for CRNAs. I just don’t see what the downside for having physician oversight is.
I’m strongly against NP independent practice, less so for CRNA independent practice.
NP school needs to be tightened up. Several friends went through and much of it is repeat basic stuff from even pre nursing. One nurse I worked with was telling me “I’m in NP school and learning about antibiotics! Did you know they work in different ways?!” And was explaining it to me. I told her “Y’all didn’t learn that in medical micro? We had to know the mechanisms of the different types. The cephalosporin generations, adjunct drugs etc”
And don’t get me started on RN to BSN. That was the biggest time wasting joke I’ve ever seen. People were posting on the discussion forum that were obviously barely literate. One still stands out.
“Let’s say your maw says you gonna bake a cake. And you says to her okay what we need to bake this here cake?”
I was in shock. Is this the future of academia?
Okay, but we're not talk ing about NP programs or RN-BSN. We're talking about CRNA programs, full stop.
Specializes in Nurse Leader specializing in Labor & Delivery.
1 hour ago, ArmyRntoMD said:
So why do LPNs not give IV medications? Are there studies saying its less safe? Or administering blood?
Because many nurse practice acts forbid it. I work with LPNs who are just as safe and effective as RNs, but state law limits their scope of practice (and actually, the LPNs I work with CAN give IV medications, and CAN administer blood after the first 15 minutes, so).
ArmyRntoMD, BSN, RN
314 Posts
So these scientific studies take into account everything? I can guarantee you that if there is a complex case, an MD will be overseeing it. So even if both CRNAs and MDs have equivalent outcomes, that doesn’t mean that the competence is equal. Also, the studies I’ve seen don’t include near misses as incidents. Studies have limitations. Sometimes you have to take a step back and look at the actual education. Premed, medical, residency, fellowship, and attending practice.